ABC of child abuse. Head injuries.

Head injuries with or without fracture ofthe skull feed. Serious intracranial injury is extremely are the commonest cause ofdeath from battering, unlikely. but abdominal injury to the gut or solid organs The force entailed in physical abuse-for can mimic the signs ofhead injury and can lead to example, in swinging the child, in violent death if they are unrecognised. uncontrolled shaking, and in hitting the child's head with a fist or-foot or against a wall-is so much greater that the pattern ofinjury is Detecting head injuries due to physical abuse different.-Fractures are more likely to be When an infant rolls off a changing table, extensive, multiple, complex or branched, hospital trolley, or bed, even on to a hard floor, he depressed, wide, separated, and growing and to is unlikely to sustain a fracture of the skull and is affect several of the individual skull bones. The almost certainly assured of escaping from major occipital bone and base of the skull, which are intracranial injury. Falls from greater heights hardly ever fractured in simple falls, are common (between 1 and 2 m), as, for example, from a sites of injury. standing adult's shoulder, may result in a single These differences are shown in the table. linear parietal hairline fracture of the skull, and Children who have been shaken but have not the infant may be irritable, vomit, or refuse a suffered blunt trauma to the head will have no